Culture

Disturbed sleep linked to mental health problems in natural disaster survivors

SAN ANTONIO - Preliminary results from a new study suggest that sleep disturbances are associated with mental health problems among survivors of a natural disaster even two years after the event.

The researchers surveyed survivors two years after the 2010 earthquake in Haiti. Results show that 94% reported experiencing subsequent insomnia symptoms after the disaster. Two years later, 42% showed clinically significant levels of post-traumatic stress disorder (PTSD), and nearly 22% had symptoms of depression. There were significant positive correlations between sleep disturbances and peritraumatic distress (i.e., emotional reaction during and immediately after the event), PTSD, and symptoms of depression. Resilience did not appear to be a buffer against sleep disturbance.

"This is one of the first epidemiological studies to investigate the prevalence of sleep disturbances among survivors of the 2010 Haiti earthquake," said lead author and principal investigator Judite Blanc, Ph.D., an NIH T32 postdoctoral fellow in the Center for Healthful Behavior Change within the Division of Health and Behavior in the Department of Population Health at NYU School of Medicine. "Our study underscores the strong association between common trauma-related disorders and comorbid sleep conditions among a group of survivors."

The study involved 165 participants with a mean age of about 31 years; 52% were men. Participants were living in Port-au-Prince, Haiti, one of the areas affected by the 2010 earthquake. According to the authors, it was the most devastating earthquake in the country's history, killing more than 200,000 people and displacing more than 1 million residents.

Measures included demographic factors, the Peritraumatic Distress Inventory, the PTSD Checklist Specific, the Beck Depression Inventory, and the Connor-Davidson Resilience Scale. Spearman correlations and multilinear regressions were used to explore associations among resilience, PTSD, depression, and sleep disturbances.

"Findings from our study highlight the need to assess and treat sleep issues among disaster survivors, as they are highly prevalent after a natural disaster and are related to mental health conditions," said Blanc. "Our work supports the importance of sleep in disaster preparedness programs globally."

Blanc added that sleep is often neglected in the aftermath of traumatic events, but in these situations, sleep should be considered an important target of mental and physical health interventions.

"Our results make the case that sleep health should be a major component of all public and global health programs and specifically in humanitarian crises," said Blanc.

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Tuesday, June 11, in San Antonio at SLEEP 2019, the 33rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

Credit: 
American Academy of Sleep Medicine

How much would you pay to eliminate child labor from your cocoa?

An increase in cocoa price by 2.8 percent could potentially eliminate the very worst forms of child labor from cocoa production in Ghana, according to a new economic model described in a study published June 5, 2019 in the open-access journal PLOS ONE by Jeff Luckstead and Lawton L. Nalley from the University of Arkansas, USA, and Francis Tsiboe from Kansas State University, USA.

Current Ghanaian law prohibits child labor; however, traditionally, children begin to learn and use cocoa farming skills in childhood - and in 2015, just under 40 percent of children working in the cocoa sector were involved in hazardous work. Many cocoa households live in poverty on small-plot farms and need children to work in order to earn enough to survive. As such, current child labor laws are rarely enforced. Complicating matters, child labor in cocoa production is not just a symptom of poverty but also a contributing factor, as children often give up a formal education to work in cocoa orchards.

In this study, the authors used data drawn from a literature review of agricultural policy to develop an economic model for the necessary price increase of cocoa in order to eliminate different types of child labor at Ghanian cocoa household-farms. The model assumes that the price premium mitigates the negative financial effects for the household of eliminating child labor, maintaining current living standards.

The model suggests that eliminating the worst forms of child labor could require a cocoa price increase of 2.81 percent; eliminating the regular work as well as the worst forms of child labor would require an 11.81 percent premium. Eliminating all forms of child labor, including light work, would require a 46.96 percent premium. However, the study did not investigate if consumers would be willing to pay these suggested premiums. The authors also noted that if cocoa farmers were not compensated in this way for eliminating forms of child labor, farm welfare and net income would decline.

Using this forecast, the authors propose that the well-established Ghanaian Cocoa Marketing Board encourage cocoa farmers to eliminate regular and hazardous child labor with an 11.81 percent price premium as compensation. This cost might be recouped by charging a premium for cocoa marketed as child labor-free.

Credit: 
PLOS

Mature galaxy mesmerizes in new Hubble view

image: NGC 7773 is a beautiful example of a barred spiral galaxy. A luminous bar-shaped structure cuts prominently through the galaxy's bright core, extending to the inner boundary of NGC 7773's sweeping, pinwheel-like spiral arms. Astronomers think that these bar structures emerge later in the lifetime of a galaxy.

Image: 
ESA/Hubble & NASA, J. Walsh

This striking image was taken by the NASA/ESA Hubble Space Telescope's Wide Field Camera 3 (WFC3), a powerful instrument installed on the telescope in 2009. WFC3 is responsible for many of Hubble's most breathtaking and iconic photographs.

Shown here, NGC 7773 is a beautiful example of a barred spiral galaxy. A luminous bar-shaped structure cuts prominently through the galaxy's bright core, extending to the inner boundary of NGC 7773's sweeping, pinwheel-like spiral arms. Astronomers think that these bar structures emerge later in the lifetime of a galaxy, as star-forming material makes its way towards the galactic center -- younger spirals do not feature barred structures as often as older spirals do, suggesting that bars are a sign of galactic maturity. They are also thought to act as stellar nurseries, as they gleam brightly with copious numbers of youthful stars.

Our galaxy, the Milky Way, is thought to be a barred spiral like NGC 7773. By studying galactic specimens such as NGC 7773 throughout the universe, researchers hope to learn more about the processes that have shaped -- and continue to shape -- our cosmic home.

Credit: 
NASA/Goddard Space Flight Center

Researchers see stress and trauma in women's stories about abortion

BUFFALO, N.Y. - A University at Buffalo-led research team has used public narratives, an increasingly popular form of person-centered advocacy offering a forum for sharing previously untold stories, to study the undue stress experienced by women in relation to abortion.

Storytelling is a universal characteristic of humanity, present throughout history and manifest in every culture. Stories told over time on similar themes present rich patterns that enhance understanding, encourage empathy and provide insights into a lived experience that can be unfamiliar to its audience.

The Tennessee Stories Project -- a regional initiative that provides space for people with Tennessee-related experiences to find affirmation and form community through storytelling -- serves as an abortion narrative platform similar to what is trending on the national level in the #YouKnowMe stories recently initiated by actress Busy Philipps.

"Many researchers are looking at epidemiological factors surrounding abortion, but from a social work practice perspective we recognized there is stress inherent in the abortion experience, especially in the Southeast. We wanted to conduct a formal qualitative analysis to examine stress in these stories," says Gretchen Ely, an associate professor in the UB School of Social Work, who co-led the study with Mickey Sperlich, a UB assistant professor of social work.

The study results allowed the researchers to categorize themes related to stress, which has the potential to inform intervention and policy.

"Our analysis indicates that stress was found to be present throughout the abortion narratives in four distinct categories: existing stressors prior to the abortion, stressors experienced while attempting to access an abortion, stressors experienced during abortion obtainment and stressors arising after the abortion. A better understanding of when stress is occurring can help educate social workers and other front-line providers, and inform their clinical care and practice responses and improve policy development," says Sperlich.

The researchers used a trauma-informed approach to design their study, published in the Journal of Social Work, a framework that recognizes trauma often exists in the lives of people who are seeking health and social services.

At its core, a trauma-informed approach asks, "What happened?" not "What's wrong?"

"With that in mind, we looked at these 39 narratives for signs where women who experienced trauma are potentially re-triggered by the stress present in their abortion-seeking experience, not the abortion itself," says Sperlich. "I'm cognizant that many people seeking abortion are not only dealing with an unwanted pregnancy, but may be dealing with other stressors and traumas, such as homelessness, partner violence or rape."

Abortion is legal at the federal level, but federal funds from programs such as Medicaid can't be used to cover abortion expenses. State laws requiring things like mandatory waiting periods further restrict access, and are common in Tennessee and throughout the Southeast. If the abortion bans proposed most recently in states like Alabama and Missouri are allowed to stand, whole swaths of the region will be without legal abortion services, creating more stress for abortion seekers.

These potential bans, existing restrictions, abortion stigma, negative interactions with protestors and personal hardships "make the process of trying to access an abortion in the Tennessee and throughout the Southeast fraught and stressful," according to the researchers.

"We have to consider these stories are from a Southeastern state, and represent people who often have a great many stressful burdens to overcome," says Ely. "Abortion bans in places like Alabama just compound the stress and potentially exacerbate trauma, but do nothing to reduce the actual rates of abortions in the region. They would just delay legal abortion access, or force people to manage abortions illegally on their own.

"For some reason, we don't seem to realize that these people are our community members, who, for whatever reason, don't feel their bodies or psyches can bear a child," Ely adds. "Because of that they're in a dire situation and need access to safe and legal health care in the geographic areas where they reside."

Credit: 
University at Buffalo

Four new species of plume moths discovered in Bahamas

image: These four moths are holotypes, the representative specimens of a species. Clockwise from top left, they are Michaelophorus salensis, Hellinsia bahamensis, Hellinsia lucayana and Oidaematophorus androsensis.

Image: 
Jeff Gage/Florida Museum

GAINESVILLE, Fla. --- Deborah Matthews hunts for plume moths in darkness, waiting for the halo of her headlamp to catch a brief flicker. About the size of mosquitoes, the delicate, feathery moths fly only a few feet at a time. Matthews must watch for that short flight while keeping clear of poisonwood, cracks in the limestone and sinkholes, common hazards of fieldwork in the Bahamas.

Her vigilance, deftness with a net and more than 30 years' experience working on plume moths and their host plants helped her discover four new species, bringing the number of known plume moth species on the islands to 23.

Plume moths are microlepidoptera, another name for tiny moths, and are understudied compared with larger, more charismatic species. But when Matthews, a biological scientist at the Florida Museum of Natural History, first joined a plume moth research project in 1987, she got hooked.

"They were just so unique," she said. "It's the symmetry that really gets you, the flower-like symmetry of the wing shape. When you take a closer look, you see that there are some pretty cool patterns."

The moths are named for the unusual, fringelike scales on their wings. In their typical stance - wings held perpendicular to their body and long hindlegs extended - they resemble small stars. Found around the world, plume moths can be beneficial insects and pests. Some species serve as pollinators while others feed on plants as larvae.

The Bahamas shares 18 of its plume moth species with Florida and 10 with Cuba. While little is known about the life histories of many plume moths, they play a key role in their ecosystems, and some species have only been found on one or two islands, Matthews said.

"They're part of the food web and part of the countless biodiversity treasures discovered in the Bahamas," she said. "It's important to know what you have in an area before it's lost."

Matthews started her Bahamian plume moth work as part of a wide-sweeping project, partially funded by the National Geographic Society, to document all of the islands' butterfly and moth diversity. Led by Florida Museum curator Jacqueline Miller, the team sampled pinelands, dunes, mangroves, rocky coasts and even dumps across the archipelago. They began their survey in 2010 with a list of about 300 species. Now, it is nearly 1,000.

"Look how far we've come in that short amount of time," Matthews said. "And we still don't know what some of these species are."

The four new species of plume moths are Michaelophorus salensis, named for the salt mining industry of Great Inagua, the main island where the moth was found; Oidaematophorus androsensis, named for Andros, the only island on which it has been found; Hellinsia bahamensis, named for the Bahamas; and Hellinsia lucayana, named in honor of the Lucayans, the indigenous people who once inhabited the islands.

Matthews initially mistook M. salensis for its close relative Michaelophorus indentatus until she dissected its genitalia to create an illustration for her study.

"I said, 'Oh my gosh, this is something I haven't seen before,'" she said. "Looking at the genitalia is really important. We find so many cryptic species that way."

The chance discovery of M. salensis is one example of why collecting and studying specimens is so crucial, Matthews said.

"You can't just take pictures in the field and describe a new species or even identify them," she said. "You really need specimens to do this."

Matthews brought out two wooden boxes at the museum's McGuire Center for Lepidoptera and Biodiversity. Inside are all of the known plume moth specimens from the Bahamas, except two that Matthews deposited in a Canadian collection and two at the Smithsonian.

"That's it for the entire world," Matthews said. "I have a big responsibility here. It's pretty mind-boggling."

Credit: 
Florida Museum of Natural History

Study links sleep-disordered breathing to age acceleration

SAN ANTONIO - Increasing severity of sleep-disordered breathing and sleep disruption are associated with epigenetic age acceleration, according to preliminary results of a new study.

Results show that each standard deviation increase in the apnea-hypopnea index, a measure of sleep-disordered breathing severity, was associated with the equivalent of 215 days of biological age acceleration. Similarly, each standard deviation increase in the arousal index, a measure of sleep disruption, was associated with the equivalent of 321 days of age acceleration.

"People's biological age might not be the same as their chronological age," said lead author Xiaoyu Li, Sc.D., a postdoctoral research fellow in the Division of Sleep and Circadian Disorders in the Department of Medicine at Brigham and Women's Hospital and the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts. "Individuals whose biological age is higher than their chronological age exhibit age acceleration or fast aging. In our study, we found that more severe sleep-disordered breathing is associated with epigenetic age acceleration. Our data provide biological evidence supporting adverse physiological and health effects of untreated sleep-disordered breathing."

Sleep-disordered breathing, such as obstructive sleep apnea, is characterized by abnormalities of respiration during sleep. Episodes often result in reductions in blood oxygen saturation and are usually terminated by brief arousals from sleep. Nearly 30 million adults in the U.S. have obstructive sleep apnea. Common warning signs include snoring and excessive daytime sleepiness.

According to the authors, epigenetic age acceleration is a DNA methylation-based marker of fast biological aging, and it is associated with modifiable lifestyle factors. Although sleep-disordered breathing is associated with multiple age-related health disorders, its relationship with epigenetic aging has not been well studied.

The study involved 622 adults with a mean age of 69 years; 53.2% were women. Participants were measured for blood DNA methylation, and their sleep was evaluated at home by polysomnography. Age acceleration measures were calculated as residuals from the regression of each epigenetic age on chronological age. The association of each sleep-disordered breathing trait with age acceleration was estimated using linear regression, controlling for socio-demographics, health behaviors, body mass index, and study site.

Another surprising finding was that the associations were stronger in women than in men, suggesting that women may be particularly vulnerable to the adverse effects of sleep-disordered breathing.

"While women are often considered to be at lower risk for health outcomes related to sleep-disordered breathing, our findings suggest increased biological susceptibility," said Li.

The authors suggested that future work should study whether treatment reduces epigenetic age acceleration among people who have sleep-disordered breathing.

"Since sleep-disordered breathing is not only common and treatable, but often undiagnosed and under-treated, our data highlight the potential for sleep-disordered breathing treatment to improve age-related chronic conditions and longevity," said Li. "Because epigenetic changes are reversible, epigenetic age estimators may be useful for identifying and validating anti-aging interventions."

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Wednesday, June 12, in San Antonio at SLEEP 2019, the 33rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

Credit: 
American Academy of Sleep Medicine

The hidden secrets of creating a viral YouTube ad

Researchers from the University of Southern California, University of Houston, and Uber Technologies, Inc. published a new paper in the Journal of Marketing, which finds that in order to create viral ads, brands should arouse strong emotion, place brand mentions at the end of the video, keep ads to a moderate length of 1.0 to 1.5 minutes, and use authentic characters. To arouse emotions, a brand should create an ad with a captivating plot, a surprising ending, and authentic characters; they also should use babies and animals more than celebrities.

The study forthcoming in the July issue of the Journal of Marketing titled "The Critical Role of Information, Emotion, and Brand Prominence," is authored by Gerard J. Tellis, Deborah J. MacInnis, Seshadri Tirunillai, and Yanwei (Wayne) Zhang.

YouTube is a media channel where millions of users create and share billions of videos without charge. It has also become a key platform for advertisers. Brands value YouTube because of the opportunity to reach more than one billion unique users who watch more than one billion hours of video daily. YouTube provides a low-cost and flexible platform for sharing ads with a path to wide viewership if an ad goes viral.

The research team tested five hypotheses about what drives sharing of video ads across social media, using two independent field studies that analyzed 11 measures of emotion and over 60 ad characteristics. The study included 109 brands that were among the top 100 US advertisers in 2012 as well as additional brands that were historically active on YouTube.

Key findings include:

Of the ads studied, 10% were not shared at all and more than 50% were shared fewer than 158 times.

Information appeals have a strong negative effect on sharing except when the advertised item involves risky purchase contexts such as new or high-priced products.

Ads that evoke positive emotions of inspiration, warmth, amusement, and excitement stimulate strong positive sharing. Despite this fact, only 7% of YouTube ads studied evoked positive emotions. An example is Budweiser's Puppy Love ad that portrays a warm drama of a puppy that falls in love with a Clydesdale horse, is separated by the owner, and is rescued by the horse.

Ads that use drama, plot, surprise, and characters (such as celebrities, babies, and animals) evoke emotions and induce sharing. Yet only 11% of ads studied used strong drama and only 10% evoked surprise. In addition, 26% of ads featured celebrities, but only 3% used babies and animals, even though the latter are more effective at driving shares.

Prominent brand placement impairs sharing: Lengthy, early, or intermittent placement of the brand name drives less sharing than late placement. Surprisingly, only 30% of the ads studied used late placement.

Ads between 1.2 to 1.7 minutes in length are the most shared. However, among the ads we shared, only 25% were between 1.0 and 1.5 minutes. Fifty percent of the ads were shorter than a minute and about 25% were longer than 2.0 minutes.

Emotional ads are shared more on general platforms (Facebook, Google+ (which shut down in August 2019), and Twitter) than on LinkedIn. The reverse holds for informational ads.

"Our findings provide marketing and media managers, advertisers, and copywriters with specific theory-based insights into how to design ads to drive virality," says Tellis. "While the old mantra touted exposure, exposure, exposure for brand names, we find that minimal brand exposure, discreet information, and strong emotion are key drivers of virality."

Credit: 
American Marketing Association

Fishers keen to help address the problem of marine litter

image: Amity skipper Jimmy Buchan with some of the litter caught by his vessel.

Image: 
Fishing for Litter

Commercial fishers are acutely aware of the potential for marine litter to cause lasting damage to their catches and the wider industry, a new study suggests.

They also appreciate they can be part of the solution, but believe others - including the shipping and offshore industries - could be doing more to support their efforts to prevent items of marine litter ending up in our oceans.

The research, published in Marine Pollution Bulletin and funded by the Department for Environment Food and Rural Affairs, assessed fishers' perceptions of Fishing for Litter (FFL) - an initiative that has been operating around the British coastline since 2005.

With hubs in Scotland and the South West of England, its aim is to reduce the amount of marine litter in our seas by physically removing it, while also highlighting the importance of good waste management among the fleet.

Researchers at the University of Surrey and the University of Plymouth spoke to around 120 fishers and other stakeholders, including boat owners and crew both signed up and not registered with the FFL initiative.

Overall, fishers said they often found marine litter in their hauls, adding it was extremely important to manage waste responsibly at sea and on the coast, and that keeping the sea and coasts clean was important to them.

They also believed similar attitudes were held throughout the fishing industry, adding that most fishers assumed responsibility for their own waste and for disposing of it in a responsible manner.

Those surveyed were also broadly supportive of the FFL programme, with scheme members reporting less environmentally harmful waste management behaviours at sea and in other contexts than their non-FFL counterparts.

Dr Kayleigh Wyles, now a Lecturer in Environmental Psychology at the University of Surrey, conducted the research while at the University of Plymouth. She said: "Marine litter is a global, persistent, and increasing threat to the oceans, and there are many great initiatives which are currently working to address this. Fishing for Litter is a unique example, accessing remote and hard to reach marine litter. Our study shows it makes use of people in the right place at the right time, and empowers fishers to do something about a problem that directly affects them (both whilst at work but also during their leisure time). As such, it can make an important contribution to an issue which might often seem to sit across boundaries and policies."

Associate Professor (Reader) in Psychology Dr Sabine Pahl, from the University of Plymouth's International Marine Litter Research Unit, added: "The responsibility for marine litter does not sit at the door of any one industry or organisation. However, it does require a collective global change of behaviour and that is something we should all be working to address. Our study shows fishers are passionate about their seas, and ultimately this is a positive initiative that others - whether they work on land or at sea - can emulate as we look to reduce the global impact of marine litter now and in the future."

The FFL schemes in Scotland and the South West are led by KIMO UK, an association of coastal local authorities whose goal is to eliminate pollution from the Northern Seas, with member ships given special bags that they then use to dispose and collect marine litter.

The latest reports showed that 230 vessels in Scotland and 160 in the South West are signed up to the scheme, and together they have collected more than 1,600 tons of marine litter since the scheme's UK inception.

Faron McLellan, KIMO UK Coordinator, added: "We at KIMO are so grateful for the research carried out on this study. One of the most important observations highlighted is the environmental motivations from the participating vessels. We see this on a daily basis but it's something we feel the public may not be aware of, and for it to be recognised in such a study is really important. Being able to identify the strengths and weaknesses of the Fishing For Litter scheme is key for both the success and expansion of our project. Many of the outcomes listed can be adopted within our current grant phases and we look forward to implementing them in due course."

Credit: 
University of Plymouth

Teens sleep longer, are more alert for homework when school starts later

SAN ANTONIO - Preliminary findings from a new study of middle school and high school students suggest that they got more sleep and were less likely to feel too sleepy to do homework after their district changed to later school start times.

In fall 2017, the Cherry Creek School District in Greenwood Village, Colorado, delayed school start times for middle school by 50 minutes (changing from 8 a.m. to 8:50 a.m.) and for high school by 70 minutes (changing from 7:10 a.m. to 8:20 a.m.). Results show that one year after the change, self-reported sleep on school nights was 31 minutes longer among middle school students and 48 minutes longer among high school students.

"Biological changes in the circadian rhythm, or internal clock, during puberty prevents teens from falling asleep early enough to get sufficient sleep when faced with early school start times," said principal investigator Lisa J. Meltzer, Ph.D., an associate professor of pediatrics at National Jewish Health in Denver, Colorado. "This study provides additional support that delaying middle and high school start times results in increased sleep duration for adolescents due to later wake times."

The American Academy of Sleep Medicine recommends that middle schools and high schools should start at 8:30 a.m. or later to support teen health, alertness and safety. However, a previous data analysis by the Centers for Disease Control and Prevention found that only 14% of high schools and 19% of middle schools started at 8:30 a.m. or later.

The study involved more than 15,000 students in grades 6-11 who completed online surveys during school hours before the start time change in spring 2017 (n=15,700) and after the start time change in spring 2018 (n=18,607). The survey included questions asking about weekday and weekend bedtime, wake time and total sleep time; sleepiness during homework; and academic engagement.

The study also found that the percentage of students who reported feeling too sleepy to do their homework declined after the school start time delay from 46% to 35% among middle school students and from 71% to 56% among high school students. Scores on a measure of academic engagement were significantly higher after the start time change for both middle school and high school students.

"The study findings are important because getting enough sleep is critical for adolescent development, physical health, mood, and academic success," said Meltzer.

CCSD Superintendent Dr. Scott Siegfried said that the study supports firsthand feedback he's received from students across the 108-square-mile district.

"I don't know how many of our high school students have come up to me and said, 'This has changed my life for the better.' They've told me they're getting up to an hour of additional sleep before school starts," Siegfried said. "That extra sleep makes a real difference in terms of health and wellness. The input from our students and the numbers from this landmark study point to the same conclusion: The change in our start times has been a positive step and benefited our students' everyday routines."

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Wednesday, June 12, in San Antonio at SLEEP 2019, the 33rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

Meltzer is also the senior author of another abstract from this study, "Impact of Changing School Start Times on Teachers/Staff," which found significant benefits of later school start times for middle and high school teachers and school-based staff. They reported increased sleep duration due to later wake times, as well as improvements in daytime functioning.

"This is the first large study to examine the impact of healthy school start times on teachers and staff," said Meltzer. "It is important to consider that this policy change, critical for the health and well-being of students, also impacts other members of the school community."

Credit: 
American Academy of Sleep Medicine

NHS-funded private sector hip operations worsening health inequality

New research examining the impact of outsourcing NHS hip operations to the private sector concludes that continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in the provision of elective hip operations in England.

Researchers from Newcastle University and Queen Mary University of London, publishing their findings in the Journal of the Royal Society of Medicine, analysed NHS-funded elective hip operations in England from 2003/4 to 20012/13. The results show that provision shifted from NHS providers to private providers from 2007/8. NHS provision decreased 8.6% and private provision increased 188% between 2007/8 and 2012/13.

The researchers found that private sector hip operations on NHS patients from the most affluent areas increased 288%, compared to an increase of 186% among patients from the least affluent areas between 2007/8 and 2012/13.

The 2012 Health and Social Care Act places duties on NHS England and Clinical Commissioning Groups to 'have regard to the need to reduce inequalities between patients with respect to their ability to access health services.' Dr Shailen Sutaria, Queen Mary University of London, said: "While inequalities did not increase overall during the study period, this was due to the protective and buffering effects of NHS provision, which remained the dominant provider. The situation is likely to be worse now."

Variations in elective hip operation rates are well documented, with female and older patients and those living in the most deprived areas less likely to receive treatment relative to need. The researchers found that private providers favour less extremes of ages compared to NHS providers. These patients, the researchers say, may represent more complex operations or associated co-morbidities that are excluded by private providers.

Professor Allyson Pollock, Director of the Institute of Health and Society at Newcastle University, said: "In 2017, over one-third of NHS-funded elective hip operations were performed by the private sector. If the trends here continue, whereby private provision substitutes for NHS direct provision, with risk selection favouring less deprived patients, then widening inequalities are likely."

Credit: 
SAGE

When social interaction helps you choose your food

image: The demonstrator mouse and the observer mouse are put in contact for 30 minutes.

Image: 
© UNIGE - Laboratoire Lüscher

How do we choose our food? By studying the neurobiological mechanisms involved in food choices of rodents, neuroscientists at the University of Geneva (UNIGE), Switzerland, have identified the important and lasting influence that peers can have on eating habits. Indeed, sensory stimuli linked to social contacts profoundly modify the neural connections of the networks involved in food choice, highlighting the social transmission of a food preference. In addition, these studies, published in the journal Science, highlight the role of social connection in the interpretation of sensory stimuli and in the ability to adapt to the environment. This mechanism, which appears to be deficient in people with autistic disorders, may partly explain their social difficulties.

For several years now, the brain mechanisms linked to nutrition have been under the scrutiny of Christian Lüscher's team, professor in the Department of Basic Neurosciences at UNIGE Faculty of Medicine. "To understand how the brain perceives food, we looked at food choices in an animal model, and more specifically how these choices are being built and whether they can be influenced," says Christian Lüscher.

In the wild, mice, which live in colonies of several dozen individuals, have the ability to adapt to their environment and discover new foods. However, to limit the risk of poisoning, "taster" mice are designated to assess the safety of an unknown food. "But then how do they pass on the information to their peers? Can these few mice permanently change the feeding behaviour of the whole group? We wanted to understand how, in the brain, the balance between the innate and the acquisition of new behaviour through social contact is forged," explains Michaël Loureiro, a researcher in Professor Lüscher's laboratory.

Thyme or cumin?

In nature, rodents have a clear preference for thyme over cumin, a spice they almost never consume. To test their hypothesis, the scientists tried to counterbalance this innate preference by observing two mice: one, the demonstrator, is educated to appreciate cumin. After a meal flavoured with this spice, it is brought into contact with another mouse - the observer - who, like all fellow mice, has an innate preference for thyme. The two mice share the same cage for 30 minutes. Twenty-four hours later, two meals are presented to the observer: one flavoured with cumin and the other with thyme. The observing mouse will then show a taste and interest in cumin, showing that the information between the two mice has been transmitted efficiently and durably through odorous cumin molecules that the observer detected on her peer the day before.

The researchers used methods to specifically mark the neurons engaged during the experiment in order to understand their functioning and communication properties. "We observed that not only did these neurons receive information from the olfactory sensory cortex, but also that inter-neural communication was modified as a result. Learning a new smell strengthens synaptic connections and modifies the animal's natural choice after contact with its fellow mouse according to a specific brain path: first, the olfactory system detects the smell. The olfactory cortex then connects to the pre-frontal cortex, involved in decision-making choices, which in turn is connected to the ventral striatum, which manages motivation and the search for a reward," explains Michaël Loureiro.

To confirm their observations, the researchers used optogenetics - a technique that allows to precisely follow and modulate neural activity - to cancel the neural modification induced by the contact between the two mice and thus erase the memory of cumin in the observing mouse. "And the mouse turned away from the cumin. By removing the reinforcement of connections in the network that we had identified, we proved that the mechanism we suspected was necessary for learning through social contact," adds Christian Lüscher.

The basis of the social mechanisms of adaptation

The Geneva scientists demonstrate that even in mice the relationship to food is highly influenced by social interactions, to the point of disrupting physiological regulatory mechanisms. But beyond food choices, this study highlights the neurobiological mechanisms of social interactions and the learning they generate. "Understanding what networks and mechanisms are needed to integrate new information received from another individual and how this information is then used to adapt to the environment are fundamental questions," says Michaël Loureiro. "Indeed, these mechanisms appear to be dysfunctional in some neurodevelopmental disorders, such as autism spectrum disorders."

The social difficulties of people with autism may indeed stem from an inability of the sensory cortex to properly treat stimuli received from outside. Peer information would be poorly integrated into the prefrontal cortex and its transmission disrupted, making it difficult to interpret external stimuli from the outset.

Credit: 
Université de Genève

Fast and furious: detection of powerful winds driven by a supermassive black hole

The supermassive black holes in the centres of many galaxies seem to have a basic influence on their evolution. This happens during a phase in which the black hole is consuming the material of the galaxy in which it resides at a very high rate, growing in mass as it does so. During this phase we say that the galaxy has an active nucleus (AGN, for active galactic nucleus).

The effect that this activity has on the host galaxy is known as AGN feedback, and one of its properties are galactic winds: this is gas from the centre of the galaxy being driven out by the energy released by the active nucleus. These winds can reach velocities of up to thousands of kilometres per second, and in the most energetic AGNs, for example the quasars, which can clean out the centres of the galaxies impeding the formation of new stars. It has been shown that the evolution of the star formation over cosmological timescales cannot be explained without the existence of a regulating mechanism.

To study these winds in quasars the EMIR infrared spectrograph on the Gran Telescopio Canarias (GTC) was used. EMIR is an instrument developed completely in the Instituto de Astrofísica de Canarias, which is designed to study the coolest and most distant objects in the universe by analysing infrared light. Since June 2016 this has been installed at a focus of the GTC, after going through an exhaustive test phase in the workshops of the Instrument Division of the IAC headquarters in La Laguna.

The data obtained since then has been used to produce several scientific articles of which the latest is a study of the obscured quasar J1509+0434, published today in the journal Monthly Notices of the Royal Astronomical Society Letters and produced by an international team led by IAC researcher Cristina Ramos Almeida. This quasar is in the local universe, and is an analogue of the more distant and far more numerous quasars in which AGN feedback must be affecting in a major way the formation of new stars.

"EMIR has allowed us to study the winds of ionized and molecular gas from this quasar by using the infrared range. This analysis is very important because they don't always show similar properties, which tells us a great deal about how these winds are produced and how they affect their host galaxies", explains Ramos Almeida. The study of this and other local quasars will allow us to understand what was happening in galaxies when they were younger and when they were forming their structures which we see today.

Based on the new data obtained with EMIR, the team has discovered that the ionized wind is faster than the molecular wind, reaching velocities of up to 1,200 km/s. However it would be the molecular wind which is emptying the gas reservoirs of the galaxy (up to 176 solar masses per year). "New observations with ALMA will let us confirm this estimate", explained José Acosta Pulido, a researcher at the IAC and co-author of this study.

The next step is to observe a complete sample of obscured nearby quasars with EMIR to study their ionized and molecular winds. We also want to investigate the stellar populations of their host galaxies. This will allow us to confirm directly the effect of AGN feedback on the evolution of the galaxies.

Credit: 
Instituto de Astrofísica de Canarias (IAC)

Naloxone access law in Pennsylvania falls short

A new study from researchers at the University of Illinois at Chicago finds that only one-third of pharmacies in Philadelphia carry naloxone nasal spray, a medication used to rapidly counter the effects of opioid overdose, and that many of the pharmacies that do carry the drug require patients to have a physician's prescription for it.

Pennsylvania has one of the highest rates of death by opioid overdose in the U.S. and was the first state to implement a statewide standing order for the drug, which is commonly known as Narcan. The law was intended to increase the availability of the potentially life-saving opioid antidote by allowing pharmacists to dispense the drug to anyone.

However, findings from this study suggest that Pennsylvania's naloxone access law, which was enacted in 2015, is not fully implemented -- putting many communities at risk.

The study, which is published in JAMA Network Open, relied on primary data collected by phone from nearly all of Philadelphia's community pharmacies in 2017.

Senior author Dima Qato, associate professor of pharmacy systems, outcomes and policy at UIC's College of Pharmacy, says that these findings provide evidence that despite statewide efforts to improve community access to naloxone, unnecessary barriers remain -- including for people who may benefit most from the drug.

"Efforts to strengthen the implementation of naloxone access laws, including statewide standing orders, which are considered the least restrictive, are warranted," Qato said. "Particularly for pharmacies located in communities with the highest rates of death due to opioid overdose."

Of the 418 pharmacies included in the study, only 34.2% had naloxone nasal spray in stock. Qato and her colleagues found that the drug was more likely to be available in chain stores, compared with independent stores; it was less likely to be available in stores located in predominately minority neighborhoods, compared with predominately white neighborhoods; and, most significantly, it was less likely to be available in areas with high rates of opioid overdose deaths, or OODs, compared with areas of low OODs.

Nearly 40% of the pharmacies that did stock the drug asked people to provide a prescription before making it available and many also required people to be older than 18.

"Despite the potential for naloxone access laws to prevent fatal opioid overdoses, our data shows that the laws are not enough. Policies need to be enforced and pharmacies need to be aware of and held accountable for implementing them," Qato said.

"Recent developments in Philadelphia are heartening -- including new legislation requiring pharmacies to stock naloxone and to post a sign notifying shoppers that it is stocked," said Jenny Guadamuz, a UIC Ph.D. candidate who collaborated on the study. "Our study provides an important baseline to evaluate continued efforts to improve naloxone access and address OODs. Pharmacies can be fined $250 for each day they are not in compliance of the law. Now, the question is, will the city enforce the law?"

"While mandating pharmacies to stock naloxone is important, our findings suggest policies that ensure pharmacies are not imposing unnecessary dispensing restrictions, including individual prescription or age requirements, are also critical," Qato said. "Naloxone access laws may fail to prevent opioid overdose deaths if they are not enforced."

Credit: 
University of Illinois Chicago

Firearms and risk of suicide by US army soldiers

Bottom Line: Examining to what extent firearm ownership and accessibility may be associated with suicide risk among U.S Army soldiers was the aim of this psychological autopsy study. The study included 135 soldiers who died by suicide on active duty between 2011-2013; firearms were the most common method with 61 of 111 soldiers who had a documented method of injury dying this way. Other soldiers were included for comparison based on sociodemographic and Army history risk factors for suicide death, as well as soldiers with recent suicidal thoughts. Next-of-kin and Army supervisors were interviewed about soldiers who died by suicide. Soldiers who died by suicide were more likely to own firearms, store loaded firearms at home, and carry personal guns in public than some other soldiers, and those factors combined were associated with an increased likelihood of suicide death. The study was limited by the small number of soldiers included. The results suggest a continued focus on lethal means counseling is warranted and one aspect of focus could be the separate storage of ammunition and firearms.

Authors: Catherine L. Dempsey, Ph.D., Uniformed Services University of the Health Sciences, Bethesda, Maryland, and coauthors

(doi:10.1001/jamanetworkopen.2019.5383)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Credit: 
JAMA Network

Availability of opioid-overdose antidote at pharmacies

Bottom Line: Pennsylvania became one of the first states in 2015 to implement a statewide standing order allowing pharmacists to dispense naloxone, an antidote for opioid overdoses, without a physician's prescription. This study looked at the availability (with or without a prescription) of naloxone nasal spray at 418 pharmacies in Philadelphia surveyed by telephone. The authors report 1 in 3 pharmacies had naloxone nasal spray in stock but many still required a physician's prescription. Naloxone also was more likely to be in stock and available without a prescription at chain stores than independent ones but naloxone was less likely to be available in areas with elevated rates of opioid overdose deaths. Researchers examined only the availability of naloxone as a nasal spray, and not in other forms, which may have underestimated its availability. The findings suggest efforts are needed to strengthen the implementation of statewide standing orders for the availability of naloxone.

Authors: Dima M. Qato, Pharm.D., M.P.H., Ph.D., University of Illinois at Chicago, and coauthors

(doi:10.1001/jamanetworkopen.2019.5388)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Credit: 
JAMA Network